UTI's Flashcards
Ciprofloxacin side effects
- musculoskeletal - tendonitis, tendon rupture (athletes)
- CNS disturbance - seizures with pre-existing CNS disorders
Ciprofloxacin interactions
CYP450 inhibitor
- rifampicin antagonist
- NSAIDS and Phenytoin
- antacids
Cephalosporins (UTI)
- first line in pregnancy
- ceftriaxone, cefpodoxime, cefipime
- time-dependent
Cefpodoxime side effects
-Neurotoxicity (hallucination, convulsion)
Cefpodoxime interactions
- Warfarin (potentiates)
- Probenecid (decreased cefpodoxime concentration in urine)
- alcohol (extreme hangover)
Penicillin (UTI)
- 2nd line in pregnancy
- Co-amoxiclav (amoxicillin + clavulanic acid)
- time-dependent
Amoxicillin interactions
- oral contraceptives
- allopurinol - increased risk of rash
- warfarin (potentiates)
Co-trimoxazole (UTI)
- in case of penicillin allergy
- sulphamethoxazole (inhibits PABA incorporation)
- trimethoprim (dihydrofolate reductase)
- inhibits tetrahydrofolic acid synthesis
- t1/2 = 9h
Co-trimoxazole side effects (UTI)
-hyperkalemia - trimethoprim
Sulphamethoxazole:
-hypersensitivity (Stevens Johnson syndrome, rash)
-Infectious diarrhea (pseudomembranous colitis - C. difficile)
Co-trimoxazole contraindications (UTI)
- pregnancy
- infants
Co-trimoxazole interactions (UTI)
- alcohol (trimethoprim)
- Digoxin, phenytoin (increased plasma concentration)
- Warfarin, sulphonylureas (potentiates)
- Zidovudine (increased toxicity)
Fosfomycin
- acute uncomplicated lower UTI’s of females >5y
- broad spectrum
- single mega dose (resistance develops quickly)
Fosfomycin side effects & contraindications
- GIT disturbances (diarrhoea, vomiting)
- Hypersensitivity (rashes, hives)
- interacts with metoclopramide (decreases concentration of fosfomycin)
Nitrofurantoin
- uncomplicated lower UTI’s
- not effective against Pseudomonas or Proteus
- resistance develops quickly
Nitrofurantoin side effects
- Pulmonary - fibrosis
- Allergies (rash, hives)
- CNS disturbance (headaches, nausea, nystagmus)
- Neurotoxicity (peripheral neuropathy)
Nitrofurantoin contraindications
- pregnant females (hemolytic anemia in fetus)
- do not use in renal impairment
Nitrofurantoin interactions
- Levlonumide
- Probenecid
- Quinolones
- Minerals
Aminoglycosides (UTI)
- for multi-drug resistant UTI’s only
- in combination with B-lactam (synergy)
- Gentamicin, Tobramycin, Amikacin
- inhibits protein synthesis
- IV or IM administration
Gentamicin side effects
- ototoxicity
- nephrotoxicity
- neuromuscular blockade
Gentamicin contraindications
- pregnancy (affects development of 8th cranial nerve)
- myasthenia gravis - increased risk of neuromuscular blockade
Gentamicin interactions
- muscle relaxants (potentiates)
- nephrotoxic drugs (loop diuretics etc) - increased effect
Imipenem/Cilastatin
- for complicated/nosocomial UTI’s
- cilastatin inhibits dehydropeptidases (degrade imipenem)
Imipenem/Cilastatin side effects
- CNS disturbances - seizures
- allergic reaction (rash)
Imipenem/Cilastatin interactions
- Tramadol
- Valproic acid
- Bupropion
- Fluoroquinolones
Piperacillin/Tazobactam
- Complicated/nosocomial UTI’s
- Piperacillin: inhibits cell wall sythesis (sensitive to B-lactamases)
- Tazobactam: inhibits B-lactamase
- synergystic with aminoglycosides against Ps. aeruginosa
Piperacillin/Tazobactam side effects and interactions
- similar to other penicillins
- interacts with probenecid (decreased urinary excretion)
Quinolones (UTI)
- ciprofloxacin, ofloxacin - treat uncomplicated UTI’s
- inhibit DNA gyrase - inhibit DNA replication
- do not give to pregnant females or children
